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目的:探讨术中先行肠腔分流(mesocaval shunt,MCS)辅助的联合血管切除的胰十二指肠切除术(pancreaticoduodenectomy with venous reconstruction,PDVR)(MCS-PDVR)的优势及可行性。方法 :对本中心2014年5月—2016年5月期间实施MCSPDVR的7例胰腺癌患者的临床资料作回顾性分析。结果:本组患者均成功实施MCS-PDVR,血管切除长度为4.0~7.0 cm,门静脉阻断时间为60~80 min,均无小肠淤血坏死,术后患者肝功能基本恢复正常,无肝性脑病发生,仅1例出现A级胰瘘,均无严重胰瘘、腹腔出血及血栓形成等严重并发症;2例术后7个月因肿瘤复发死亡,5例随访中,随访时间6~14个月,无复发迹象。结论:MCS-PDVR作为严重侵犯肠系膜上静脉和(或)门静脉的晚期胰腺癌的一种手术方式不仅安全可行,而且可以提高手术切除率,达到R0切除,延长患者的生存时间。
Objective: To investigate the advantages and feasibility of intraoperative preoperative cocasal shunt (MCS) assisted by combined vascular resection of pancreaticoduodenectomy with venous reconstruction (MCS-PDVR). Methods: The clinical data of 7 patients with pancreatic cancer who underwent MCSPDVR between May 2014 and May 2016 in our center were retrospectively analyzed. Results: MCS-PDVR was successfully performed in all patients. The length of resection was 4.0-7.0 cm and the portal vein occlusion time was 60-80 min. No intestinal congestion necrosis was found. The postoperative liver function returned to normal, and no hepatic encephalopathy Occurred in only 1 case of grade A pancreatic fistula, no severe pancreatic fistula, abdominal bleeding and thrombosis and other serious complications; 2 patients died of tumor recurrence 7 months after surgery, 5 cases were followed up, the time of 6-14 Month, no signs of recurrence. CONCLUSIONS: MCS-PDVR is a safe and feasible method for severe pancreatic cancer invaded into superior mesenteric vein and / or portal vein. It can improve the resection rate, achieve R0 resection and prolong the survival time of patients.